Frailty and Malnutrition Are Associated With Inpatient Postoperative Complications and Mortality in Hip Fracture Patients

Abstract

Objective: To examine the relationship of nutrition parameters with the modified frailty index (mFI) and postoperative complications in hip fracture patients. Design: Retrospective observational cohort study. Setting: Urban, American College of Surgeons–Verified, Level-1, Trauma Center. Patients/Participants: Three hundred seventy-seven consecutive patients with isolated hip fractures. Intervention: N/A. Main Outcome Measures: On admission, albumin and total lymphocyte count (TLC) levels and complication data were collected. Additionally, mFI scores were calculated. Statistical analysis was then used to analyze the association between frailty, malnutrition, and postoperative complications. Results: Overall, 62.6% and 17.5% of patients were malnourished as defined by TLC of <1500 cells per cubic millimeter and albumin of <3.5 g/dL, respectively. Both TLC (P = 0.024; r = −0.12) and albumin (P < 0.001; r = −0.23) weakly correlated with frailty. Combining malnutrition and frailty revealed predictive synergy. Albumin of <3.5 g/dL and mFI of ≥0.18 in the same patient resulted in a positive predictive value of 69% and a likelihood ratio of 4 (2.15–7.43) for postoperative complications. Similarly, the combination of hypoalbuminemia and frailty resulted in a positive predictive value of 23.3% and likelihood ratio of 8.52 (P < 0.001) for mortality. Conclusions: When patients are frail and malnourished, there is a risk elevation beyond that of frailty or malnutrition in isolation. This high-risk cohort can be easily identified at admission with routine laboratory values and clinical history. There is an opportunity to improve outcomes in frail hip fracture patients because malnutrition represents a potentially modifiable risk factor. Level of Evidence: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Preoperative Ascorbic Acid Levels in Proximal Femur Fracture Patients Have No Postoperative Clinical Impact, While Ascorbic Acid Levels upon Discharge Have a Major Effect on Postoperative Outcome

“…Although preoperatively there were no significant connections between malnutrition and postoperative complication, 6-8 weeks after surgery there were strong correlations towards the MNA status and the NRS status. This shows a major influence of clinical parameters and malnutrition on the postoperative complications and rehabilitation [51]. Both scores are frequently used with geriatric patients.…”

“…The mobility upon discharge has a major impact on postoperative survival. Preoperative improvements on these basic clinical parameters as well as supporting postoperative mobility and self-sufficiency significantly reduces postoperative mortality [45,51]. Limited access to daily nutrition, impaired mobility and dependent living conditions prior to surgery facilitate postoperative mortality within 6-8 weeks after surgery.…”

Malnutrition and its effects in severely injured trauma patients

“…Thirteen cohort studies reported on the prevalence of malnutrition in severely injured trauma patients ( Table 1). The prevalence of malnutrition ranged from 7 to 76% in trauma patients in general [10,[25][26][27][28][29][30][31][32][34][35][36]. Six studies specifically reported the prevalence of malnutrition on geriatric patients admitted with traumatic injuries.…”

“…Six studies specifically reported the prevalence of malnutrition on geriatric patients admitted with traumatic injuries. On admission, 7-62.6% of the geriatric trauma patients were malnourished and 35.6-60% were at risk for malnutrition according to the Mini Nutritional Assessment (MNA) tool, Nutritional Risk Screening (NRS 2002) tool and serum biomarkers (visceral proteins) [26,27,29,30,35,36]. Dhandapani et al also examined the development of malnutrition during hospital stay and showed an increase in prevalence from 45% in the first week of hospital admission to 76% in the third week [25].…”

Using Global Criteria to Detect Malnutrition: Application in Disease States

“…Since this time, it has become clear that malnutrition in patients who are undergoing major surgery are at considerable risk for increased mortality and morbidity . A multitude of research highlights the risk of postoperative complications in malnourished patients undergoing orthopedic procedures, colorectal surgery, bariatric surgery, and other major surgery…”